<!DOCTYPE html>
<html lang="en">
<head>
  <title>Bootstrap 实例</title>
  <meta charset="utf-8">
  <meta name="viewport" content="width=device-width, initial-scale=1">
  <link href="https://cdn.jsdelivr.net/npm/bootstrap@5.1.2/dist/css/bootstrap.min.css" rel="stylesheet">
  <script src="https://cdn.jsdelivr.net/npm/bootstrap@5.1.2/dist/js/bootstrap.bundle.min.js"></script>
</head>
<body>

<div class="container mt-3">
  <h2>添加就诊人</h2>
  <form action="/action_page.php">
    <div class="mb-3 mt-3">
      <label for="name">姓名：</label>
      <input type="text" class="form-control" id="name" placeholder="请输入姓名" name="username">
    </div>
    <div class="mb-3">
      <label for="phonenumber">电话号码：</label>
      <input type="text" class="form-control" id="phonenumber" placeholder="请输入电话号码" name="phonenumber">
    </div>
    <div class="mb-3">
        <label for="Idnumber">身份证号：</label>
        <input type="text" class="form-control" id="Idnumber" placeholder="请输入身份证号" name="Inumber">
      </div>
      <p>性别：<input type="radio" class="form-check-input" id="man" name="sex" value="1" checked>
        <label class="form-check-label" for="man">男</label>
        <input type="radio" class="form-check-input" id="woman" name="sex" value="0">
        <label class="form-check-label" for="woman">女</label>
        </p>

    <div class="form-check mb-3">
      <label class="form-check-label">
        <input class="form-check-input" type="checkbox" name="remember">记住我
      </label>
    </div>
    <div>
      <label for="birthday">出生日期</label>
      <input type="date" id="birthday" name="birthday"class="form-control" value="<%= LocalDate.now() %>">
    </div>

    <div style="margin-top: 10px;">
      选择科室:
    <select name="department"  class="form-select" aria-label="Default select example">
      <option selected >内科</option>
      <option value="1">外科</option>
      <option value="2">妇产科</option>
      <option value="3">儿科</option>
      <option selected>眼科</option>
      <option value="1">口腔科</option>
      <option value="2">皮肤科</option>
      <option value="3">传染病科</option>
      <option value="3">精神科</option>
      <option value="3">影像科</option>
      <option value="3" >麻醉科</option>
      <option value="3" class="text-primary" >急诊科</option>
    </select>

    <div style="margin-top: 10px">
    急门诊选择：
    <select name="" id=""class="form-select" aria-label="Default select example">
      <option value="" >急诊挂号</option>
      <option value=""selected>门诊挂号</option>
    </select>
  </div>
  </div>
 
    <div>
      <button type="submit" class="btn btn-primary" style="margin-top: 10px;">提交</button>
    </div>
  </form>
</div>

</body>
</html>
